The word opium is derived from the Greek name for juice as the drug is contained in the juice of the poppy, Papaver somniferum. Archeological digs in Switzerland uncovered opium poppy seeds and pods dating to the Neolithic age (8,000 B.C.-5,500 B.C.), suggesting opium was used before recorded history. The art of poppy-culling was established by the ancient Sumarians in Mesopotamia around 3500 B.C. They referred to it as hul gil, the “joy plant”. The use of the plant and its euphoric effect was passed on to its trading partners and made its way westward to Egypt and eventually to Greece and Europe. The medicinal use of opium traces back centuries and its description was first recorded by Theophrastus in the third century B.C. Hippocrates, the father of medicine, mentioned opium's usefulness in curing a number of diseases and found it particularly effective for diarrhea. Opium has been used as a cure all to relieve pain and suffering in cultures around the world throughout history.
Around 1500 Portuguese sailors began mixing opium with tobacco and smoking it. The effects of smoking opium produced an instantaneous euphoria. The practice spread to China and lead to an increased demand for opium which greatly influenced both economics and politics worldwide. In 1803 Frederich Sertuerner discovered the principle active ingredient in opium: morphine, named after the Greek god of dreams. In 1827 E. Merck & Company of Darmstadt, Germany began commercial manufacturing of morphine. The medicinal and recreational use of morphine was prevalent through the rest of the 19th century. Dr. Alexander Wood of Edingburg discovered a new method of administering morphine by injection with a syringe in 1843 and found the effects were instantaneous and that morphine was three times more potent by this route.
In 1890 the U.S. Congress imposed a tax on opium and morphine in its first act to address the growing problem of addiction. Heinrich Dreser, in 1895, produced acetylated morphine for The Bayer Company of Eberfield, Germany. Acetylated morphine was named heroin and marketed commercially three years later. Heroin was purported not to have some of the common side effects as morphine and at one point was supplied as free samples in the mail by the philanthropic Saint James Society to morphine addicts who wished to break their habits. By the early 1900s heroin addiction had risen to alarming rates. In 1906 congress passed the pure food and drug act requiring contents labeling of patented medicines. As a result the availability of opiates and opiate consumers significantly declined. In 1914, the Harrison Narcotics Act required doctors, pharmacists and others who prescribe narcotics to register and pay a tax. Congress banned the sale of narcotics altogether in 1923. In the wake of the federal ban on opium trade was driven under ground. Illicit use of heroin continued with varying degrees throughout the century, and remains an enormous social problem today.
The scourge of morphine and heroin abuse lead to the search for potent analgesics that would lack the potential for addiction. In the 1940's two synthetic compounds, meperidine and methadone, were produced and found to have morphine-like actions, unfortunately, including induction of tolerance and addiction. The term opioid was coined to refer to natural and synthetic drugs that are, to varying degrees, opium or morphine like in their properties. Opioids interact with several closely related receptors and share biological properties with three families of endogenous neuropeptides, endorphins, enkaphalins, and dynorphins. A number of additional opioids were produced with varying degrees of morphine-like activity. In general, the analgesic potency of synthetic morphine agonists produces corresponding levels of tolerance and addiction. Thus attempts to find an effective morphine-like analgesic that is free of the potential for addiction have fallen short to date.
Despite their addictive properties and the potential for abuse, morphine-like drugs, particularly, codeine, hydrocodone, and oxycodone have been routinely prescribed as treatment for severe acute and chronic pain in recent decades. This is, in part, because there are no alternatives to relieve severe pain that is resistant to other less potent analgesics such as non-steroidal anti-inflammatory drugs (NSAIDS). In this regard, others have attempted to decrease the abuse potential through formulations and the inclusion of morphine antagonists such as naltrexone. These approaches, unfortunately, can be circumvented and have not solved the problem.
In 1995, Purdue Frederich introduced a high oral dose oxycodone product in a time-release formula. Initially the product was marketed in doses as high as 160 mg. Subsequently, when a problem arose with people crushing the tablets to obtain the entire dose immediately, and in some cases snorting or shooting the ingredients, the high dose (160 mg) tablet was removed from the market. The 80 mg extended release oxycodone product (Oxycontin™) is still commercially available. Abuse of Oxycontin resulted in the FDA issuing a change to the Oxycontin approved label in 2001 which included the following warning:                OXYCONTIN TABLETS ARE TO BE SWALLOWED WHOLE AND ARE NOT TO BE BROKEN, CHEWED OR CRUSHED. TAKING BROKEN, CHEWED, OR CRUSHED OXYCONTIN TABLETS LEADS TO RAPID RELEASE AND ABSORPTION OF A POTENTIALLY FATAL DOSE OF OXYCODONE.        
In recent years the misuse of opioid painkillers has nearly quadrupled. An estimated 2.4 million people in the U.S. began misusing prescription pain killers in 2001 as compared to 628,000 in 1990 according to the federal government's Survey on Drug Use and Health. An estimated 4.4 million patients take more pain medication than their prescribed amount. The rate of full blown addiction is 0.3 percent, however, any patient that does not follow their prescription is considered at risk. Pain medications prescribed for acute pain typically contain about 5 to 10 mg of hydrocodone, oxycodone, or codiene.
Hydrocodone is an opioid analgesic and antitussive and occurs as fine, white crystals or as crystalline powder. Hydrocodone is a semisynthetic narcotic analgesic prepared from codeine with multiple actions qualitatively similar to those of codeine. It is mainly used as an antitussive in cough syrups and tablets in sub-analgesic doses (2.5-5 mg). Additionally, it is used for the relief of moderate to moderately severe pain.
Patients taking opioid analgesics such as hydrocodone for pain relief can become accidentally addicted. As tolerance to the opioids develops more drug is needed to stop the pain and generate the sense of well being initially achieved with the prescribed dose. This leads to dose escalation, which if left unchecked can lead rapidly to addiction. In some cases patients have become full blown addicts in as little as thirty days.
As a result of their addictive properties and potential for abuse, opioids are scheduled controlled substances and are available only by prescription. It has been suggested that this precipitates under-utilization of opioids for pain relief. Although it is well known that opioids are the most effective treatment for severe pain, their abuse liability and the potential for fatal overdose provide a legitimate concern for any physician considering their use in pain management. According to Martino, over 125 journal and periodical articles and eighteen books have been written on the subject. There is a general consensus that inadequate treatment of chronic pain is the rule in the United states and most developed nations. It has been estimated that 75 percent of the 23 million people who have surgery each year, 60 percent of the 50 million persons living with chronic pain, and 70 percent of persons with cancer pain do not receive adequate pain management. In this regard, thirty-three states have enacted laws (intractable pain treatment acts (IPTAs)) designed to provide physicians with some measure of regulatory relief by reducing the real and perceived risks of being subjected to sanctions for treating pain with opioids.
There appears to be a direct correlation of diversion of prescribed opioids with the number of prescriptions per capita. As prescription numbers rise, the number of emergency room visits and deaths from overdose increase correspondingly. For example, the number of prescriptions for hydrocodone products rose from 56 million in 1998 to 89 million in 2000.